Digestive Health - Guided Imagery and Meditation Blog | Health JourneysFind helpful information and tips on Health Journeys' blog. Our guided imagery and meditation blog features content authored by Belleruth Naparstekhttp://blog.healthjourneys.com/digestive-health/feed/atom.html2018-03-19T10:51:12-04:00Joomla! - Open Source Content ManagementStrictly Psychological Methods Not So Effective with IBS (Irritable Bowel Syndrome)2009-03-29T19:00:00-04:002009-03-29T19:00:00-04:00http://blog.healthjourneys.com/hot-research/strictly-psychological-methods-not-so-effective-with-ibs-irritable-bowel-syndrome.htmlBelleruth Naparstekdesign@emediacy.net<div class="K2FeedIntroText"><p>Investigators from the Julius Center for Health Sciences and Primary Care at the <strong>University Medical Center Utrecht</strong> in the Netherlands, reviewed the research literature on efficacy of psychological interventions for the treatment of irritable bowel syndrome. <br />
<br />MEDLINE, EMBASE, PsychInfo, CINAHL, Web of Science, The Cochrane Library and Google Scholar identified 25 randomized trials comparing single psychological interventions with either usual care or placebo interventions in patients over 16 years of age, between the years 1966-2008.&nbsp;&nbsp; </p></div><div class="K2FeedFullText"><p>Psychological interventions were found to be slightly superior to usual care or wait list control conditions at the end of treatment, although the clinical significance of this was debatable*. Except for a single study, psychological therapies were not superior to placebo and the sustainability of their effect was questionable. There was no convincing evidence that treatment effects were sustained following completion of treatment for any treatment modality.<br />
&nbsp;<br />
Meta-analysis was significantly limited by issues of validity, heterogeneity, small sample size and outcome definition. The authors recommend that future research adhere to current recommendations for IBS treatment trials, and should focus on the long-term effects of treatment.<br />
&nbsp;<br />
*[For those interested in some of the statistical details, the relative risk (RR), risk difference (RD), number needed to treat (NNT) and standardized mean difference (SMD) along with 95% confidence intervals were calculated using a random effects model for each outcome. Results for&nbsp; psychological interventions as a group: the SMD for symptom score improvement at 2 and 3 months was 0.97 (95% CI 0.29 to 1.65) and 0.62 (95% CI 0.45 to 0.79) respectively, compared to usual care. Against placebo, the SMDs were 0.71 (95% CI 0.08 to 1.33) and -0.17 (95% CI -0.45 to 0.11) respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.54 (95%CI 0.10 to 0.98) and 0.26 (95% CI 0.07 to 0.45) compared to usual care. The SMD from placebo at 3 months was 0.31 (95% CI -0.16 to 0.79). For improvement in quality of life, the SMD from usual care at 2 and 3 months was 0.47 (95%CI 0.11 to 0.84) and 0.31 (95%CI -0.16 to 0.77) respectively. <br />
<br />Results for cognitive behavioral therapy: The SMD for symptom score improvement at 2 and 3 months was 0.75 (95% CI -0.20 to 1.70) and 0.58 (95% CI 0.36 to 0.79) respectively compared to usual care. Against placebo, the SMDs were 0.68 (95% CI -0.01 to 1.36) and -0.17 (95% CI -0.45 to 0.11) respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.45 (95% CI 0.00 to 0.91) and 0.22 (95% CI -0.04 to -0.49) compared to usual care. Against placebo the SMD at 3 months was 0.33 (95% CI -0.16 to 0.82). For improvement in quality of life, the SMDs at 2 and 3 months compared to usual care were 0.44 (95% CI 0.04 to 0.85) and 0.92 (95% CI 0.07 to 1.77) respectively.<br />
<br />Results for interpersonal psychotherapy: The RR for adequate relief of symptoms was 2.02 (95% CI 1.13 to 3.62), RD 0.30 (95% CI 0.13 to 0.46), NNT 4 for comparison with care as usual. The SMD for improvement of symptom score was 0.35 (95% CI -0.75 to 0.05) compared with usual care. Relaxation/Stress management The SMD in symptom score improvement at 2 months was 0.50 (95%CI 0.02 to 0.98) compared with usual care. The SMD in improvement of abdominal pain at 3 months was 0.02 (95%CI -0.56 to 0.61) compared with usual care.] </p>
<p>There were very few long term follow-up results available. <br />
<br /><strong>Citation;&nbsp; <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&amp;Cmd=Search&amp;Term=%22Zijdenbos%20IL%22%5BAuthor%5D&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus" target="_blank">Zijdenbos IL</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&amp;Cmd=Search&amp;Term=%22de%20Wit%20NJ%22%5BAuthor%5D&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus" target="_blank">de Wit NJ</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&amp;Cmd=Search&amp;Term=%22van%20der%20Heijden%20GJ%22%5BAuthor%5D&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus" target="_blank">van der Heijden GJ</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&amp;Cmd=Search&amp;Term=%22Rubin%20G%22%5BAuthor%5D&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus" target="_blank">Rubin G</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&amp;Cmd=Search&amp;Term=%22Quartero%20AO%22%5BAuthor%5D&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus" target="_blank">Quartero AO</a>.&nbsp; <a href="http://www.ncbi.nlm.nih.gov/pubmed/19160286?ordinalpos=2&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum" title="Psychological treatments for the management of irritable bowel syndrome" target="_blank">Psychological treatments for the management of irritable bowel syndrome</a>. Cochrane Database Syst Rev.2009 Jan 21;(1): CD006442</strong><br />
&nbsp;</p></div><div class="K2FeedIntroText"><p>Investigators from the Julius Center for Health Sciences and Primary Care at the <strong>University Medical Center Utrecht</strong> in the Netherlands, reviewed the research literature on efficacy of psychological interventions for the treatment of irritable bowel syndrome. <br />
<br />MEDLINE, EMBASE, PsychInfo, CINAHL, Web of Science, The Cochrane Library and Google Scholar identified 25 randomized trials comparing single psychological interventions with either usual care or placebo interventions in patients over 16 years of age, between the years 1966-2008.&nbsp;&nbsp; </p></div><div class="K2FeedFullText"><p>Psychological interventions were found to be slightly superior to usual care or wait list control conditions at the end of treatment, although the clinical significance of this was debatable*. Except for a single study, psychological therapies were not superior to placebo and the sustainability of their effect was questionable. There was no convincing evidence that treatment effects were sustained following completion of treatment for any treatment modality.<br />
&nbsp;<br />
Meta-analysis was significantly limited by issues of validity, heterogeneity, small sample size and outcome definition. The authors recommend that future research adhere to current recommendations for IBS treatment trials, and should focus on the long-term effects of treatment.<br />
&nbsp;<br />
*[For those interested in some of the statistical details, the relative risk (RR), risk difference (RD), number needed to treat (NNT) and standardized mean difference (SMD) along with 95% confidence intervals were calculated using a random effects model for each outcome. Results for&nbsp; psychological interventions as a group: the SMD for symptom score improvement at 2 and 3 months was 0.97 (95% CI 0.29 to 1.65) and 0.62 (95% CI 0.45 to 0.79) respectively, compared to usual care. Against placebo, the SMDs were 0.71 (95% CI 0.08 to 1.33) and -0.17 (95% CI -0.45 to 0.11) respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.54 (95%CI 0.10 to 0.98) and 0.26 (95% CI 0.07 to 0.45) compared to usual care. The SMD from placebo at 3 months was 0.31 (95% CI -0.16 to 0.79). For improvement in quality of life, the SMD from usual care at 2 and 3 months was 0.47 (95%CI 0.11 to 0.84) and 0.31 (95%CI -0.16 to 0.77) respectively. <br />
<br />Results for cognitive behavioral therapy: The SMD for symptom score improvement at 2 and 3 months was 0.75 (95% CI -0.20 to 1.70) and 0.58 (95% CI 0.36 to 0.79) respectively compared to usual care. Against placebo, the SMDs were 0.68 (95% CI -0.01 to 1.36) and -0.17 (95% CI -0.45 to 0.11) respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.45 (95% CI 0.00 to 0.91) and 0.22 (95% CI -0.04 to -0.49) compared to usual care. Against placebo the SMD at 3 months was 0.33 (95% CI -0.16 to 0.82). For improvement in quality of life, the SMDs at 2 and 3 months compared to usual care were 0.44 (95% CI 0.04 to 0.85) and 0.92 (95% CI 0.07 to 1.77) respectively.<br />
<br />Results for interpersonal psychotherapy: The RR for adequate relief of symptoms was 2.02 (95% CI 1.13 to 3.62), RD 0.30 (95% CI 0.13 to 0.46), NNT 4 for comparison with care as usual. The SMD for improvement of symptom score was 0.35 (95% CI -0.75 to 0.05) compared with usual care. Relaxation/Stress management The SMD in symptom score improvement at 2 months was 0.50 (95%CI 0.02 to 0.98) compared with usual care. The SMD in improvement of abdominal pain at 3 months was 0.02 (95%CI -0.56 to 0.61) compared with usual care.] </p>
<p>There were very few long term follow-up results available. <br />
<br /><strong>Citation;&nbsp; <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&amp;Cmd=Search&amp;Term=%22Zijdenbos%20IL%22%5BAuthor%5D&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus" target="_blank">Zijdenbos IL</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&amp;Cmd=Search&amp;Term=%22de%20Wit%20NJ%22%5BAuthor%5D&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus" target="_blank">de Wit NJ</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&amp;Cmd=Search&amp;Term=%22van%20der%20Heijden%20GJ%22%5BAuthor%5D&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus" target="_blank">van der Heijden GJ</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&amp;Cmd=Search&amp;Term=%22Rubin%20G%22%5BAuthor%5D&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus" target="_blank">Rubin G</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&amp;Cmd=Search&amp;Term=%22Quartero%20AO%22%5BAuthor%5D&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus" target="_blank">Quartero AO</a>.&nbsp; <a href="http://www.ncbi.nlm.nih.gov/pubmed/19160286?ordinalpos=2&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum" title="Psychological treatments for the management of irritable bowel syndrome" target="_blank">Psychological treatments for the management of irritable bowel syndrome</a>. Cochrane Database Syst Rev.2009 Jan 21;(1): CD006442</strong><br />
&nbsp;</p></div>Long-term improvement in functional dyspepsia using hypnotherapy.2003-08-15T02:59:11-04:002003-08-15T02:59:11-04:00http://blog.healthjourneys.com/hot-research/long-term-improvement-in-functional-dyspepsia-using-hypnotherapy.htmlBelleruth Naparstekdesign@emediacy.net<div class="K2FeedIntroText"><p>This study assessed the efficacy of hypnotherapy in treating
functional dyspepsia (FD). A total of 126 patients were randomized to
either a hypnotherapy condition, a supportive therapy plus placebo
medication condition, or a medical treatment condition, for a total of
16 weeks of treatment. </p>
<p>The percentage of change in symptoms from baseline was
assessed after the 16-week treatment phase (short-term) and again after
56 weeks (long-term), with the 26 hypnotherapy, 24 supportive therapy,
and 29 medical treatment patients who completed all phases of the
study. In addition, quality of life was also measured as a secondary
outcome. </p></div><div class="K2FeedFullText"><p>Investigators found that short-term symptom scores improved more in the hypnotherapy group (median, 59%) than in the supportive group (41%; P = 0.01) or in the medical treatment group (33%; P = 0.057). Hypnotherapy also benefited quality of life more, (42%) when compared with either supportive therapy (10% [P &lt; 0.001]) or medical treatment (11% [P &lt; 0.001]). </p>
<p>In addition, in the long-term, after the 56 week interval, it was found that hypnotherapy even more significantly improved symptoms (73%), as compared with supportive therapy (34% [P &lt; 0.02]) or medical treatment (43% [P &lt; 0.01]). Also, quality of life improved significantly more with hypnosis (44%) than with medical treatment (20% [P &lt; 0.001]). There were similar improvements in quality of life found in the supportive therapy group, (43%) but it should be noted that 5 of these patients commenced taking antidepressants during follow-up. </p>
<p>
Another finding of note: a total of 90% of the patients in the medical treatment group and 82% of the patients in the supportive therapy group commenced medication during follow-up, whereas none in the hypnotherapy group did so (P &lt; 0.001). Further, patients in the hypnosis group visited their general practitioner or gastroenterologist significantly less (median, 1) than did those in the supportive therapy (median, 4) and medical treatment (median, 4) groups during follow-up (P &lt; 0.001). </p>
<p>The study concludes that hypnotherapy is highly effective in the long-term management of functional dyspepsia. Furthermore, the dramatic reduction in medication use and consultation rate provide major economic advantages.<br />
<br />Citation: Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ. Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology, 2002. Dec; 123 (6): pp. 1778-85.</p></div><div class="K2FeedIntroText"><p>This study assessed the efficacy of hypnotherapy in treating
functional dyspepsia (FD). A total of 126 patients were randomized to
either a hypnotherapy condition, a supportive therapy plus placebo
medication condition, or a medical treatment condition, for a total of
16 weeks of treatment. </p>
<p>The percentage of change in symptoms from baseline was
assessed after the 16-week treatment phase (short-term) and again after
56 weeks (long-term), with the 26 hypnotherapy, 24 supportive therapy,
and 29 medical treatment patients who completed all phases of the
study. In addition, quality of life was also measured as a secondary
outcome. </p></div><div class="K2FeedFullText"><p>Investigators found that short-term symptom scores improved more in the hypnotherapy group (median, 59%) than in the supportive group (41%; P = 0.01) or in the medical treatment group (33%; P = 0.057). Hypnotherapy also benefited quality of life more, (42%) when compared with either supportive therapy (10% [P &lt; 0.001]) or medical treatment (11% [P &lt; 0.001]). </p>
<p>In addition, in the long-term, after the 56 week interval, it was found that hypnotherapy even more significantly improved symptoms (73%), as compared with supportive therapy (34% [P &lt; 0.02]) or medical treatment (43% [P &lt; 0.01]). Also, quality of life improved significantly more with hypnosis (44%) than with medical treatment (20% [P &lt; 0.001]). There were similar improvements in quality of life found in the supportive therapy group, (43%) but it should be noted that 5 of these patients commenced taking antidepressants during follow-up. </p>
<p>
Another finding of note: a total of 90% of the patients in the medical treatment group and 82% of the patients in the supportive therapy group commenced medication during follow-up, whereas none in the hypnotherapy group did so (P &lt; 0.001). Further, patients in the hypnosis group visited their general practitioner or gastroenterologist significantly less (median, 1) than did those in the supportive therapy (median, 4) and medical treatment (median, 4) groups during follow-up (P &lt; 0.001). </p>
<p>The study concludes that hypnotherapy is highly effective in the long-term management of functional dyspepsia. Furthermore, the dramatic reduction in medication use and consultation rate provide major economic advantages.<br />
<br />Citation: Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ. Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology, 2002. Dec; 123 (6): pp. 1778-85.</p></div>